Chronic Pain Lawyers in Ontario

Yes. You can always submit an application if your employer’s benefits package included short-term or long-term disability benefits.

If you have developed anxiety or depression as a result of workplace stress/burnout, to the point where you have a condition that renders you unable to work, you can make an application for long-term disability benefits.

People make claims for disabilities such as:

• Mental Illnesses including Depression, Anxiety and Bipolar Disorder
• Chronic conditions such as Fibromyalgia and Chronic Fatigue Syndrome
• Physical injuries such as fractures and spinal cord injuries
• Cardiovascular Disease
• Neurological conditions such as Parkinson’s Disease, Multiple Sclerosis, Stroke
• Traumatic Brain Injuries
• Arthritis Conditions such as Osteoarthritis, Lupus, Psoriatic Arthritis, Fibromyalgia, Gout, Rheumatoid Arthritis and Scleroderma
• Gastrointestinal issues including Irritable Bowel Syndrome, Colitis, Crohn’s Disease, Diverticulitis and Diverticulosis
• Gynecological issues including Endometriosis
• Complications from Diabetes including Retinopathy, Peripheral Neuropathy, Charcot Fractures, Osteomyelitis
• Cancers and cancer treatments
• Complications related to cancer treatment including pain, fatigue, lymphedema, depression, anxiety

Many long-term disability (LTD) policies have a “recurrence” clause, which means that if you return to work but are unable to continue working as a result of the same disability, you will not have to submit a new application. Instead, you can make a ‘recurrent’ claim. Under some policies, the time limit to make a claim for a recurrent disability is 6 months.

During a claim for long-term disability benefits (or if your benefits have been denied during the lawsuit), if you have extended health care benefits that are usually paid for by your employer your benefits should still be available to you if you are still an employee.

If your claim for long-term disability benefits has been denied, by hiring a disability lawyer, you can start a court action against your insurance company.

What you are suing for is a declaration of coverage (that you are entitled to benefits) and a reinstatement of benefits (also referred to as getting back on claim).

When settlement of your case occurs, you have the option of receiving a lump-sum settlement or reinstatement of benefits. It is often the case that a lump-sum settlement occurs. If you have questions about the legal process or how a lawsuit works, contact a disability lawyer today.

Each long-term disability policy may be different, but in order to qualify for benefits, a person must meet the definition of totally disabled.

A total disability means that you are reasonably unable to carry out the normal functions of your job. It does not mean that you have to be completely physically unable to do any part of your job, but that your injury or illness is such that common sense requires you to stop working so you can focus on getting better. As a result of your injuries or illness, you are unable to perform the essential duties of your own occupation.

This is the definition your insurer will go by during the “own occupation” period of your disability. When the own occupation is over, you are considered totally disabled if you are unable to perform any occupation for which you are reasonably suited for or could become suited for.

You should review the definitions section of your policy, or have a lawyer review it, to find out what your LTD policy states.

If you have access to STD benefits and don't receive payments for the whole period, that doesn't necessarily mean that you are no longer disabled from working. STD benefits are paid for a specified period of time. It usually this covers the "qualifying period" for LTD benefits.

In order to receive and qualify for LTD benefits, you need to meet the requirements for disability during the waiting period.

Even if your insurance company did not pay you the full amount of short-term disability benefits, or does not feel you meet the qualifying period, you should still apply for long-term disability benefits if you are still unable to work and if your doctors continue to support that you are disabled.

In a long-term disability claim, you are assessed as to whether or not you can perform the essential duties of a) your own occupation and b) any occupation. In most policies, the own occupation period lasts for 2 years, but this depends on the policy.

Own occupation refers to your pre-disability occupation; the job you held at the time your disability occurred.

Any occupation refers to any occupation for which you are reasonably qualified, or could become qualified for by reason of education, training or experience.

Own Occupation Test

This test applies to the first 24 months of disability (or the period set out in your policy). Total disability during this period of time means that you are unable to work at your own occupation and perform the essential duties of your job.

Any Occupation Test

Total disability refers to the inability to work at any occupation. After the 24 month period, your continued eligibility for long-term disability benefits will be based on whether you are unable to perform the essential duties of any occupation for which you are reasonably qualified. This includes occupations you could become qualified for by reason of education, training or experience. 

It is important to read your own policy to find out what tests are applicable and when they apply. 

Your insurer may try to coordinate what is known as a graduated return to work program with your employer. A graduated return to work is a schedule that gradually increases the number of hours and days you work until you reach full time hours and days at work. This may include modified duties if you are unable to resume your regular duties.

Usually your insurer will write to your treating physician and treatment providers to get approval for the graduated return to work plan, and to determine your restrictions and limitations.

If the graduated return to work plan and returning to work increases your symptoms, and you are unable to continue working, you must provide supportive medical evidence to your insurer. If you are unable to participate in the program entirely, you would also need to provide supportive medical evidence showing that your symptoms would be made worse if you participated.

Your insurer may arrange what is known as a “work hardening program” for you if they feel that you would benefit from a rehabilitation program that prepares you for a return to work. For example, if you have chronic pain, you may receive physiotherapy sessions, chronic pain education and cognitive behavioural therapy sessions in order to prepare you for a return to work.

If the program makes your symptoms worse, or you are unable to participate, you must provide medical evidence to support your medical status and/or inability to participate in the program or are unable to complete it.

An independent medical examination is an in-person assessment with a doctor chosen by the insurance company. Throughout your disability claim, or during a lawsuit against your insurer, it is important to attend scheduled appointments made by your insurance company to show that you are a willing participant in the legal process.

During your disability claim, your insurance company may request that you be seen for an assessment so that they can obtain an opinion about your condition. It is important to attend this appointment, and to honestly answer all questions asked by the assessor.

If you are responsible for paying a premium for LTD benefits, if applicable, when your benefits are approved, the insurer typically will approve you for a waiver of premiums for long-term disability and optional life benefits. This means you do not need to pay premiums as long as you meet the test for total disability. If your claim is denied, you need to continue paying premiums in order to maintain your coverage.

Some policies have what is called a "no evidence maximum”, which means there is a maximum benefit amount you can receive without providing proof of medical evidence. The policy may have a formula, but you can only be paid a benefit up to the no evidence maximum, which may be less than what you could be entitled to. For example, the policy may have a $1,000 limit, but your earnings are $5,000 monthly. The benefit formula is the lesser of 50% of monthly earnings or the no evidence maximum, so you would only receive $1,000.

Basic earnings refer to the regular salary you receive from your employer, not including any overtime, bonus pay or incentives.